1.Outcomes and Prognostic Factors for Severe Community-Acquired Pneumonia that Requires Mechanical Ventilation.
Jin Hwa LEE ; Yon Ju RYU ; Eun Mi CHUN ; Jung Hyun CHANG
The Korean Journal of Internal Medicine 2007;22(3):157-163
BACKGROUND: Community-acquired pneumonia (CAP) remains a common and serious condition worldwide. The mortality from severe CAP remains high, and this has reached 50% in some series. This study was conducted to determine the mortality and predictors that contribute to in-hospital mortality for patients who exhibit CAP and acute respiratory failure that requires mechanical ventilation. METHODS: We retrospectively reviewed the medical records of 85 patients with severe CAP as a primary cause of acute respiratory failure, and this required mechanical ventilation in a setting of the medical intensive care unit (ICU) of a tertiary university hospital between 2000 and 2003. RESULTS: The overall in-hospital mortality was 56% (48/85). A Cox-proportional hazard model revealed that the independent predictive factors of in-hospital mortality included a PaCO2 of less than 45 mmHg (p<0.001, relative risk [RR]: 4.73; 95% confidence interval [CI]: 2.16-10.33), a first 24-hour urine output of less than 1.5 L (p=0.006, RR: 2.46, 95% CI: 1.29-4.66) and a high APACHE II score (p=0.004, RR: 1.09, 95% CI: 1.03-1.16). CONCLUSIONS: Acute respiratory failure caused by severe CAP and that necessitates mechanical ventilation is associated with a high mortality rate. Initial hypercapnia and a large urine output favored survival, whereas a high APACHE II score predicted mortality.
Aged
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Aged, 80 and over
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Community-Acquired Infections/complications/mortality/therapy
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Female
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Hospital Mortality
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Humans
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Hypercapnia
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Male
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Middle Aged
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Pneumonia, Bacterial/complications/*diagnosis/*mortality/therapy
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Predictive Value of Tests
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Prognosis
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Respiration, Artificial
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Respiratory Insufficiency/*diagnosis/etiology/*mortality/therapy
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Retrospective Studies
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Treatment Outcome
2.Emphasize the diagnosis and treatment of infective endocarditis in patients with severe burn.
Chinese Journal of Burns 2016;32(2):74-76
The incidence and mortality of infective endocarditis (IE) in patients with severe burn remain high, which are attributed to invasive procedures, bacteremia, and wound infection after burns. Clinical clues for IE in burns are usually masked by burn-related manifestations, so the diagnosis of IE may be delayed or missed. For burned patients with persistent bacteremia of unknown source, especially Staphylococcus aureus-induced bacteremia, the diagnosis of IE should be considered according to the Duke criteria, and early echocardiography performance is particularly important. Antibiotic therapy is the mainstay initial management, and early surgical intervention is strongly recommended once IE is clearly diagnosed in patients with burns. In order to lower the incidence and mortality of IE in burns, it is very important to take prophylactic procedures along with the whole course of burn management.
Bacteremia
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epidemiology
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Burn Units
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Burns
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complications
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mortality
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surgery
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Endocarditis, Bacterial
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complications
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diagnosis
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microbiology
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mortality
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Humans
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Incidence
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Severity of Illness Index
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Staphylococcal Infections
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complications
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diagnosis
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Staphylococcus aureus
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isolation & purification
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Surgery, Plastic
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Wound Infection
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etiology
;
mortality
3.Clinical Features, Risk Factors and Outcomes of Bacteremia due to Enterococci with High-Level Gentamicin Resistance: Comparison with Bacteremia due to Enterococci without High-Level Gentamicin Resistance.
Hee Chang JANG ; Shinwon LEE ; Kyoung Ho SONG ; Jae Hyun JEON ; Wan Beom PARK ; Sang Won PARK ; Hong Bin KIM ; Nam Joong KIM ; Eui Chong KIM ; Myoung don OH ; Kang Won CHOE
Journal of Korean Medical Science 2010;25(1):3-8
High-level gentamicin resistance (HLGR) in enterococci has increased since the 1980s, but the clinical significance of the resistance and its impact on outcome have not been established. One hundred and thirty-six patients with bacteremia caused by enterococci with HLGR (HLGR group) were compared with 79 patients with bacteremia caused by enterococci without HLGR (non-HLGR group). Hematologic malignancy, neutropenia, Enterococcus faecium infection, nosocomial infection and monomicrobial bacteremia were more common in the HLGR group than the non-HLGR group, and APACHE II scores were also higher (P<0.05, in each case). Neutropenia, monomicrobial infection, stay in intensive care at culture, and use of 3rd generation cephalosporin, were independent risk factors for acquisition of HLGR enterococcal bacteremia. Fourteen-day and 30-day mortalities were higher in the HLGR group than the non-HLGR group in univariate analysis (37% vs. 15%, P=0.001; 50% vs. 22%, P<0.001). However, HLGR was not an independent risk factor for mortality due to enterococcal bacteremia in multivariate analysis. Therefore, HLGR enterococcal bacteremia is associated with more severe comorbid conditions and higher mortality than non-HLGR enterococcal bacteremia but the HLGR itself does not contribute significantly to mortality.
Adolescent
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Adult
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Aged
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Anti-Bacterial Agents/*pharmacology
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Bacteremia/diagnosis/*etiology/*mortality
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Cephalosporins/pharmacology
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Cross Infection/complications
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Drug Resistance, Bacterial
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Enterococcus/*drug effects/isolation & purification
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Female
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Gentamicins/*pharmacology
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Gram-Positive Bacterial Infections/diagnosis/*etiology/*mortality
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Humans
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Male
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Middle Aged
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Multivariate Analysis
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Neutropenia/complications/mortality
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Odds Ratio
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Risk Factors
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Severity of Illness Index
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Treatment Outcome
4.Clinical Characteristics and Prognostic Impact of Bacterial Infection in Hospitalized Patients with Alcoholic Liver Disease.
Jin Kyoung PARK ; Chang Hun LEE ; In Hee KIM ; Seon Min KIM ; Ji Won JANG ; Seong Hun KIM ; Sang Wook KIM ; Seung Ok LEE ; Soo Teik LEE ; Dae Ghon KIM
Journal of Korean Medical Science 2015;30(5):598-605
Bacterial infection is an important cause of death in patients with liver cirrhosis. The aim of this study was to investigate the clinical characteristics and prognostic impact of bacterial infection in hospitalized patients with alcoholic liver disease (ALD). We retrospectively analyzed data from 409 patients consecutively admitted to a tertiary referral center with ALD diagnosis. Of a total of 544 admissions, 133 (24.4%) cases presented with bacterial infection, of which 116 were community-acquired whereas 17 were hospital-acquired. The common types of infection were pneumonia (38%), biliary tract infection (17%), soft tissue infection (12%), and spontaneous bacterial peritonitis (9%). Diabetes, serum Na <135 mM/L, albumin <2.5 g/dL, C-reactive protein > or =20 mg/L, systemic inflammatory response syndrome (SIRS) positivity were independently associated with bacterial infection in patients with ALD. Overall 30-day and 90-day mortalities in patients with bacterial infection were significantly (P < 0.001) higher than those without infection (22.3% vs. 5.1% and 32.3% vs. 8.2%, respectively). Furthermore, bacterial infection (HR, 2.2; 95% CI, 1.049-4.579, P = 0.037), SIRS positivity (HR, 2.5; 95% CI, 1.240-4.861, P = 0.010), Maddrey's discriminant function score > or =32 (HR, 2.3; 95% CI, 1.036-5.222, P = 0.041), and hemoglobin <12 g/dL (HR, 2.4; 95% CI, 1.081-5.450, P = 0.032) were independent predictors of short-term mortality. In conclusion, bacterial infection and SIRS positivity predicted short-term prognosis in hospitalized patients with ALD. A thorough evaluation at admission or on clinical deterioration is required to detect possible infection with prompt management.
Adult
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Aged
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Bacterial Infections/complications/*diagnosis/mortality
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C-Reactive Protein/analysis
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Candida/isolation & purification
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Female
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Gram-Negative Bacteria/isolation & purification
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Gram-Positive Bacteria/isolation & purification
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Hemoglobins/analysis
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Hospitalization
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Humans
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Linear Models
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Liver Diseases, Alcoholic/complications/*diagnosis
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Male
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Middle Aged
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Patients
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Prognosis
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Proportional Hazards Models
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Retrospective Studies
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Risk Factors
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Serum Albumin/analysis
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Sodium/blood
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Survival Analysis
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Systemic Inflammatory Response Syndrome/complications/diagnosis
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Tertiary Care Centers